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Using spatial equity analysis in the process evaluation of environmental interventions to tackle obesity: the healthy towns programme in England.

ABSTRACT: Process evaluations of environmental public health interventions tend not to consider issues of spatial equity in programme delivery. However, an intervention is unlikely to be effective if it is not accessible to those in need. Methods are required to enable these considerations to be integrated into evaluations. Using the Healthy Towns programme in England, we demonstrate the potential of spatial equity analysis in the evaluation of environmental interventions for diet and physical activity, examining whether the programme was delivered to those in greatest need.Locations of new physical infrastructure, such as cycle lanes, gyms and allotments, were mapped using a geographic information system. A targeting ratio was computed to indicate how well-located the infrastructure was in relation to those at whom it was specifically aimed, as detailed in the relevant project documentation, as well as to generally disadvantaged populations defined in terms of U.K. Census data on deprivation, age and ethnicity. Differences in targeting were examined using Kruskal-Wallis and t-tests.The 183 separate intervention components identified were generally well located, with estimated targeting ratios above unity for all population groups of need, except for black and ethnic minorities and children aged 5-19 years. There was no evidence that clustering of population groups influenced targeting, or that trade-offs existed when components were specifically targeted at more than one group.The analysis of spatial equity is a valuable initial stage in assessing the provision of environmental interventions. The Healthy Towns programme can be described as well targeted in that interventions were for the most part located near populations of need.

SUBMITTER: Dalton AM

PROVIDER: S-EPMC3693867 | biostudies-other | 2013 Jun

REPOSITORIES: biostudies-other

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Using spatial equity analysis in the process evaluation of environmental interventions to tackle obesity: the healthy towns programme in England.

Dalton Alice M AM Jones Andrew A Ogilvie David D Petticrew Mark M White Martin M Cummins Steven S

International journal for equity in health 20130617

<h4>Introduction</h4>Process evaluations of environmental public health interventions tend not to consider issues of spatial equity in programme delivery. However, an intervention is unlikely to be effective if it is not accessible to those in need. Methods are required to enable these considerations to be integrated into evaluations. Using the Healthy Towns programme in England, we demonstrate the potential of spatial equity analysis in the evaluation of environmental interventions for diet and ...[more]

PMID: 23773457

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Project description:BackgroundAlthough there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience.MethodsRelying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials.ResultsThe resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience.ConclusionsWe outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.

Project description:Despite their growing popularity, little is known about how cash transfers (CTs) can affect health equity in targeted communities. Lesotho's Child Grants Programme (CGP) is an unconditional CT targeting poor and vulnerable households with children. Started in 2009, the CGP is one of Lesotho's key programmes in developing the country's social protection system. Using the CGP's early phases as a case study, this research aims to capture how programme stakeholders understood and operationalized the concept of health equity in Lesotho's CGP. The qualitative analysis relied on the triangulation of findings from a desk review and semi-structured key informant interviews with programme stakeholders. The programme documents were coded deductively and the interview transcripts inductively. Both materials were analysed thematically before triangulating their findings. We explored determining factors for differences or disagreements within a theme according to the programme's chronology, the stakeholders' affiliations and their role(s) in the CGP. The definitions of health equity in the context of the CGP reflected an awareness among stakeholders of these issues and their determinants but also the challenges raised by the complex (or even debated) nature of the concept. The most common definition of this concept focused on children's access to health services for the most disadvantaged households, suggesting a narrow, targeted approach to health equity as targeting disadvantages. Yet, even the most common definition of this concept was not fully translated into the programme, especially in the day-to-day operations and reporting at the local level. This operationalization gap affected the study of selected health spillover effects of the CGP on health equity and might have undermined other programme impacts related to specific health disadvantages or gaps. As equity objectives become more prominent in CTs, understanding their meaning and translation into concrete, observable and measurable applications in programmes are essential to support impact.

Project description:ObjectivesParent carers of children with special educational needs or disability are at risk of poorer mental and physical health. In response to these needs, we codeveloped the 'Healthy Parent Carers' (HPC) programme. This study examined the views and experiences of participants in the HPC feasibility trial to inform programme refinement.Intervention, setting and participantsHPC is a peer-led group-based intervention (supported by online materials) for primary carers of disabled children, encouraging behaviours linked with health and well-being. It was delivered by two lead and six assistant peer facilitators in six community sites (one lead and one assistant per group) in South West England over six or 12 sessions. Control participants had online materials only. The trial involved 47 intervention and 45 control parent carers (97% female and 97% white) and eight facilitators (one male).DesignA preplanned mixed methods process evaluation using questionnaires and checklists (during and after the intervention), qualitative interviews with participants after intervention (n=18) and a focus group with facilitators after trial.ResultsHPC was highly acceptable to participants and facilitators and experiences were very positive. Participants reported that the programme increased awareness of what parent carers could and could not change and their self-efficacy to engage in health-promoting behaviours. The intended mechanisms of action (social identification and peer support) matched participants' expectations and experiences. Control participants found the online-only programme flexible but isolating, as there were no opportunities to share ideas and problem solve with peers, the key function of the programme. Areas for improvement were identified for programme content, facilitator training and delivery.ConclusionHPC was acceptable, well received and offers considerable potential to improve the health of parent carers. Under the pandemic, the challenge going forward is how best to maintain reach and fidelity to function while delivering a more virtual programme.Trial registration numberISRCTN151144652.

Project description:Following several pilot projects, in 2020, the Department for Education (DfE) in England committed funding of £220M p. a to its Holiday Activities and Food (HAF) programme to support all 153 upper-tier local authorities, comprising City Councils, County Councils and Metropolitan Borough Councils, to provide an activity and food programme for children who are in receipt of means-tested free school meals. In this study, qualitative interviews were conducted with representatives from three Local Authorities in the North East of England who were responsible for overseeing the implementation and delivery of HAF programmes in their Local Authority area to examine how the summer HAF programme was implemented during summer 2021. Interviews were conducted with eight participants prior to the implementation of the HAF programme, and four interviews were conducted after the programme had been delivered. Using a directed content analysis approach, an interpretative framework was co-developed, based on the four constructs (and selected sub-constructs) of Normalization Process Theory. This framework guided data coding. The analysis aimed to identify and understand the barriers and opportunities in relation to HAF implementation within local authorities. Participants did not perceive HAF as a totally new initiative as many had either commissioned or delivered holiday clubs in the past. However, the increased scale and scope of HAF was perceived as highly complex, involving multiple local authority departments and stakeholders. Nonetheless, HAF funding enabled local authorities to improve the quality and reach of their holiday programmes. Strong networks and good communication between all stakeholders supported successful delivery, despite tight delivery timescales. However, the rigidity of some of the DfE guidance was a barrier for some providers, particularly the recommended delivery model of 4 h a day, 4 days a week for 4 weeks, with many individual holiday clubs struggling to meet this level of delivery, and local authority leads interpreting the guidance at a club level rather than an individual child access level. Furthermore, participants considered the HAF eligibility criteria too restrictive. Many councils were developing long-term plans for HAF delivery, integrated into planning across several departments, and all local authorities were actively seeking ways to engage with and embed HAF within local communities.

Project description:Parental support interventions have shown some effectiveness in improving children's dietary and physical activity habits and preventing overweight and obesity. To date, there is limited research on barriers and facilitators of school-based parental support interventions targeting overweight and obesity. This study aimed to describe barriers and facilitators influencing implementation of the Healthy School Start (HSS) intervention in disadvantaged areas in Stockholm, Sweden, from the perspective of parents and teachers.Focus groups and individual interviews with teachers (n = 10) and focus groups with parents (n = 14) in the intervention group of the HSS were undertaken, guided by the Consolidated Framework for Implementation Research (CFIR). Transcriptions were analysed using qualitative content analysis in two steps: deductive sorting in two domains of the CFIR (intervention characteristics and process), and subsequent inductive analysis.The overarching theme "tailoring the intervention to increase participant engagement" was found. Among teachers, barriers and facilitators were related to how the intervention was introduced, perceptions of the usefulness of the classroom material, preparation ahead of the start of the intervention, cooperation between home and school and children's and parents' active engagement in the intervention activities. For parents, barriers and facilitators were related to the perceived relevance of the intervention, usefulness of the material, experiences of the Motivational Interviewing (MI) sessions, the family member targeted by the intervention, cooperation between home and school and parents' ability to act as good role models.It seems important to tailor the intervention to the abilities of the target group in order to increase participant engagement. Including activities that focus on parents as role models and cooperation between parents seems important to bring about changes in the home environment. It also appears important to include activities that target cooperation between home and school.

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Using spatial equity analysis in the process evaluation of environmental interventions to tackle obesity: the healthy towns programme in England.

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Using spatial equity analysis in the process evaluation of environmental interventions to tackle obesity: the healthy towns programme in England.

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